324 Assistive Technology Services | HCBS 5300 Manual

Georgia Division of Aging Services
Home and Community-Based Services Manual

Chapter:

300

Effective Date:

10/01/2025

Section Title:

Assistive Technology Services

Reviewed or Updated in:

MT 2026-01

Section Number:

324

Previous Update:

MT 2023-03

324.1 Purpose

This chapter establishes the requirements to be followed when Area Agencies on Aging (AAA) directly provides or contract for delivery of assistive technology services to individuals in their place of residence.

According to the Assistive Technology Act (ATA), the purpose of an assistive technology (AT) program is:

Support State efforts to improve the provision of assistive technology to individuals with disabilities through comprehensive statewide programs of technology-related assistance, for individuals with disabilities of all ages, that are designed to—
1. increase the availability of, funding for, access to, provision of, and training about assistive technology devices and assistive technology services
2. increase the ability of individuals with disabilities of all ages to secure and maintain possession of assistive technology devices as such individuals make the transition between services offered by educational or human service agencies or between settings of daily living (for example, between home and work)
3. increase the capacity of public agencies and private entities to provide and pay for assistive technology devices and assistive technology services on a statewide basis for individuals with disabilities of all ages
4. increase the involvement of individuals with disabilities and, if appropriate, their family members, guardians, advocates, and authorized representatives, in decisions related to the provision of assistive technology devices and assistive technology services
5. increase and promote coordination among State agencies, between State and local agencies, among local agencies, and between State and local agencies and private entities (such as managed care providers), that are involved or are eligible to be involved in carrying out activities under this Act
6. increase the awareness and facilitate the change of laws, regulations, policies, practices, procedures, and organizational structures, that facilitate the availability or provision of assistive technology devices and assistive technology services
7. increase awareness and knowledge of the benefits of assistive technology devices and assistive technology services among targeted individuals and entities and the general population
Provide States with financial assistance that supports programs designed to maximize the ability of individuals with disabilities and their family members, guardians, advocates, and authorized representatives to obtain assistive technology devices and assistive technology services.

324.2 Scope

The requirements apply to assistive technology services funded in whole or in part with non-Medicaid federal and state funds, managed by the AAA, and any associated matching funds. These requirements may act as guidelines for a fee-for-service model.

Under the Assistive Technology Act of 1998 (ATA), the Governor of a state shall designate a public agency as a lead agency for implementing assistive technology services. Tools for Life (TFL), a result of the Assistive Technology Act of 1998 as amended in 2004, is a program of the Georgia Institute of Technology, College of Design, Center for Inclusive Design, and Innovation (formerly AMAC Accessibility).

The Assistive Technology Act includes the following services:

Evaluating the assistive technology needs of an individual with a disability.
Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices by individuals with disabilities.
- Acquisition of devices can be done through device reutilization program and/or and device loan program
Selecting, designing, fitting, customizing, adapting, applying, maintaining, or donating (device reutilization program) assistive technology devices. Includes trial use and short-term loans of assistive technology. “Try before you buy” (device loan program).
Coordinating and using necessary therapies, interventions, or services with assistive technology devices, such as therapies, interventions, or services associated with education and rehabilitation plans and programs.
Training or technical assistance for an individual with a disability or, where appropriate, the family members, guardians, advocates, or authorized representatives of such an individual.
Training or technical assistance for professionals (including individuals providing education and rehabilitation services and entities that manufacture or sell assistive technology devices), employers, providers of employment and training services, or other individuals who provide services to, employ, or are otherwise substantially involved in the major life function of individuals with disabilities.
Expanding the availability of access to technology, including electronics and information technology, to individuals with disabilities.

Division of Aging Services (DAS) encourages AAAs to follow these ATA service definitions in establishing the scope of their assistive technology program. AAA may contract, partner, and/or establish referral mechanisms with qualified individuals or agencies to fulfill specific service activities.

324.3 Definitions with Services Provided

Assistive Technology Service: any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device.

Assistive Technology Device: any item, piece of equipment, including durable medical equipment or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of older adults and individuals with disabilities.

AT can be low-tech: grab bars, magnifiers, lever handles, shower seats/benches
AT can be high-tech: automated lights, hearing amplifiers, tablets, computers

Device Demonstration: AAAs shall directly, or in collaboration with public and private entities, such as one-stop partners demonstrate a variety of assistive technology devices and assistive technology services (including assisting individuals in making informed choices regarding, and providing experiences with, the devices and services), using personnel who are familiar with such devices and services and their applications.

Device Loan Program: AAAs shall directly, or in collaboration with public or private entities, carry out device loan programs that provide short-term loans of assistive technology devices to individuals to meet the needs of targeted individuals and entities.

Device Reutilization Programs: AAAs shall directly, or in collaboration with public or private entities, carry out assistive technology device reutilization programs that provide for the exchange, recycling, or other reutilization of assistive technology devices, which may include redistribution through device sales, loans, rentals, or donations.

324.4 Core Principles

The ATA identifies core principles that AAAs should follow in administering AT services and in serving older adults and persons with disabilities.

In serving clients, AAAs should demonstrate:

Respect for individual dignity, personal responsibility, self-determination, and pursuit of meaningful careers, based on informed choice.
Respect for the privacy, rights, and equal access (including the use of accessible formats).
Inclusion, integration, and full participation of such individuals in society.
Support for the involvement in decisions of a family member, a guardian, and advocate, or an authorized representative, if an individual with a disability request, desires, or needs such involvement.

In administering AT services, AAAs should:

Ensure that program/services are easily accessible to, and usable by, individuals with disabilities and, when appropriate, their family members, guardians, advocates, or authorized representatives.
Respond to the needs of individuals with disabilities in a timely and appropriate manner.
Facilitate the full and meaningful participation of individuals with disabilities (including individuals from underrepresented populations and rural populations) and their family members, guardians, advocates, and authorized representatives in:
- Decisions relating to the provisions of assistive technology devices and assistive technology services.
- Decisions related to the maintenance, improvement, and evaluation of the comprehensive statewide program of technology-related assistance, including decisions that affect capacity building and advocacy activities.

DAS requires that assistive technology services be delivered in a person-centered manner. Program staff should approach individuals and families with empathy and an understanding of their life experiences and challenges by searching for and acting upon what is important to that individual, including their wants, needs, and values.

DAS strongly encourages collaboration between the AAAs and the Centers for Independent Living (CIL) to facilitate access to information, resources, and education about assistive technology.

324.5 Program Objectives, Outcomes & Indicators

The primary goal of assistive technology services is to aid older adults, persons with disabilities, and their caregivers to achieve maximum self-sufficiency and enhance their quality of life.

Outcome #1: Reduce caregiver burden by providing assistive technology.

Indicators:

Reduction in intention to place as measured by Section H on the Risk Assessment Tool.
Reduced level of caregiver burden as measured by the Bakas Caregiving Outcomes Scale.

Outcome #2: Increase independence for individuals by providing assistive technology.

Indicators:

Reduction in Level of Impairment as measured by DON-R scores.
Reduction in Unmet Need for Care as measured by DON-R scores.

Outcome #3: Increase opportunities for individuals to participate in meaningful activities providing assistive technology

Indicators:

Reduction in Level of Impairment as measured by DON-R scores
Reduction in Lubben Social Network Scale and/or reduction in UCLA-3 Loneliness scale

DAS does not require that the AAA achieve every outcome and/or indicator for the delivery of assistive technology services to be deemed effective.

324.6 Target Group / Eligibility

Assistive technology services target persons who have a physical or mental disability or disorder that restricts his/her ability to perform basic activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs), or that threatens his/her capacity to live independently, and their caregivers. (See MAN 5300, CH 316 for additional priorities for caregiver services)

AAAs should follow additional criteria specific to fund sources. If funding is not sufficient to serve all eligible consumers requesting services, the Older Americans Act and Client Prioritization guidelines, found in MAN 5300, CH 118 provides for giving preference to specific persons:

Persons in greatest economic need,
Persons in greatest social need,
Persons who are at risk of institutionalization,
Underrepresented population:
- persons who are minorities,
- persons with limited English proficiency
- persons from rural areas

Individuals must have an impairment(s) and/or unmet need(s), as indicated by his/her DON-R score. AAAs should prioritize individuals who have impairment and/or unmet need in any of the domains with scores of 2 or greater.

AAAs will not provide assistive technology services in a nursing home, personal care home, or other setting where the provision of this service is included in the cost of care.

324.7 Access to Services

AAA staff shall screen individuals including identifying problems that he/she experiences in daily life and that he/she hopes are eliminated or diminished as a result by AT services.

AAA staff shall discuss with potential clients how AT can address their level of impairment, unmet need, or both. The AAA staff will initiate service delivery, refer clients to provider organizations or other resources (i.e.: Tools for Life), or place them on a waiting list for services. AAA staff shall assist in the selection, acquisition, and proper usage of identified assistive technology devices.

For information regarding screening through Aging & Disability Resource Connection, see MAN 5200, 5025 Service Availability and Access. The AAAs will maintain and manage waiting lists for the services, as necessary. See Manual 5200, 5038 Waiting List Management and Criteria for Admission to Services.

Not every applicant will request, require, or benefit from Assistive Technology services. Each AAA will clearly identify in its Area Plan how services will be coordinated and how resources will be allocated and managed to optimize the effectiveness and efficiency of Assistive Technology services.

324.8 Core Functions of Assistive Technology Services

An optimal assistive technology program requires staff who have specialized skills and competencies to provide the following core functions:

Assessment/Evaluation - includes identifying levels of impairment and/or unmet need and the individual’s capacity to effectively use assistive devices

Service/Device Acquisition – includes the purchase, loan, or acquisition of refurbished assistive devices. DAS discourages bulk purchases of assistive technology items

Education – includes training to ensure the appropriate application and use of assistive devices, education about home safety or accessing the service delivery network, and education about progression of health conditions that may impact future needs for assistive devices

Advocacy – includes coordination with other programs and advocacy on behalf of clients who require assistance in accessing other systems of care

Reassessment – includes follow-up with individuals (or their caregivers) to determine the extent to which assistive technology is adequately meeting their needs, and to adjust services as indicated

Discharge – includes documentation that services are meeting the needs of the individual/family and that the client has information about how to access additional services at a later date

324.8A Assessments

DAS requires that staff use the DON-R to determine an individual’s need and potential benefit for assistive technology. Assistive technology may reduce an individual’s level of impairment and/or their unmet need for care. The preferred method of assessment for assistive technology services is via home visit.

Staff should also assess the degree to which the individual can properly use assistive technology devices based on physical disability, cognitive impairment, or behavioral health condition. This may require referrals to experts in assessing an individual’s ability to benefit from assistive technology (ex: occupational therapy, Tools for Life, etc.).

The AAA may provide device demonstrations to determine the degree to which individuals can use or may benefit from AT. AAAs are to follow their device loan program procedures and guidelines to assist individuals in proper usage of devices (or durable medical equipment) before purchasing devices.

Staff should follow up with each individual 60 days after receiving AT devices to determine whether assistive technology devices are being used properly, whether the devices are reducing level of impairment and/or reducing unmet need for care, and whether the assistive devices are impacting the individual’s quality of life.

Staff should readminister the DON-R at least annually to determine effectiveness of assistive technology services.

For assessments of caregivers and to use assistive technology to reduce caregiver burden, refer to MAN 5300, Chapter 316 – Caregiver Services.

324.8B Education and Advocacy

The ATA states that the term “capacity building and advocacy activities” mean efforts that:

result in laws, regulations, policies, practices, procedures, or organizational structures that promote consumer-responsive programs or entities; and
facilitate and increase access to, provisions of, and funding for, assistive technology devices and assistive technology services, in order to empower individuals with disabilities to achieve greater independence, productivity, and integration and inclusion within the community and the workforce.”

To support these advocacy efforts, each AAA should include information about assistive technology in its outreach and community education, for example:

Device demonstrations
Assistive Technology labs (tours and demonstrations)
AT information posted on the AAA website

At a minimum, each AAA must provide AT device demonstrations twice a year through community outreach events.

324.8C Discharge

It is the explicit intent of DAS to serve clients in greatest need and to maximize the efficiency and effectiveness of the Aging Network.

DAS anticipates that during the span of service delivery to a consumer, the consumer’s needs, supports, and resources will change. Based upon the ongoing process of assessment and reassessment, the AAA may determine that the individual is receiving maximum benefit from assistive technology and initiate discharge according to DAS policy (see MAN 5300, 202 Program Guidelines and Requirements).

When a device such as a walker, cane, wheelchair, or other durable medical equipment is no longer useful/needed, AAAs are to follow their own procedures and guidelines to provide the individual the option to return the item for another agency or individual to re-use (device can be recycled, reused).

Staff must include proper documentation in the DDS system that includes the reason for discharge and whether the device was collected, and/or re-utilized.

324.9 Staffing and Training

General staffing information is described in MAN 5300, 202 Program Guidelines and Requirements.

Staff providing assistive technology services must view the following 3 introductory training videos (link provided below):

gatfl.gatech.edu/?title=Tools_for_Life_and_DAS_CARES_Act_Trainings_-_2021

Basic AT for Activities of Daily Living
Treasure Chest: How to Find Treasures in Funding for AT Purchases
Connections for Older Adults: How to Access Digital Services for Individuals

Staff must conduct a site visit with an existing assistive technology program within the first 3 months of employment.

Additionally, it is recommended, but not required, that staff should view the Sharpening Your Skills: Exploring Assistive Technology Toolkits PowerPoint presentation.

324.10 Conflict-Free Service

An efficient service delivery system is characterized by person-centered approaches and cost-effective outcomes for both consumers and the community. Therefore, DAS supports the implementation of a conflict-free service delivery system.

MAN 5300, 202 Program Guidelines and Requirements, Section 202.4F - Conflict-Free Service Delivery, includes the key elements included in the design of such a system.

324.11 Data Collection & Reporting

General information about data collection and reporting is described in CH 202. The AAA has discretion to require additional information systems, but it must meet the minimal standards required by DAS. The AAA must retain relevant information not captured in the DAS data system in paper files in accordance with DAS program policies.

Specific programmatic/service requirements for collection and/or reporting of data include:

Information gathered from persons served.
Appropriate consent forms, issued or approved by DAS
Provider information
Pertinent financial information regarding applicable cost shares
Coordination with the ADRC regarding waiting lists and referrals to assistive technology services
Tools and plans for measuring quality of life and customer satisfaction approved or required by DAS
Notation in the DAS data system that includes the name of the device and the cost of the device
Documentation of education and advocacy efforts (see 324.9B)

The AAA staff will use data from the DAS data system, at a minimum, to facilitate quality improvement and data analysis.

324.12 Client Records & Activities

All client records will be maintained pursuant to MAN 5300, Chapter 202 Program Guidelines and Requirements, Section 202.5 “Program Guidelines and Requirements,” MAN 5600, Chapter 1025 - Section 1050 “Technology and Data Management,” MAN 5600, Chapter 1025 - Section 1053 “Records Retention,” and MAN 5600, Chapter 3000 - Section 3005 “Area Agency on Aging Records.”

Each client record must include the following information about assistive technology devices\services in the manner that DAS requires:

Type(s) of assistive technology
Cost for each assistive device(s)

324.13 Client Safety and Well-Being

AAA staff should practice diligence to promote the safety and well-being of individuals to whom the AAA provides assistive technology, including:

Proper installation or assembly of assistive device
Documentation that the individual has the capacity and knowledge to use the assistive device safely
Documentation that the individual and/or their support system has received training in the proper use of the assistive device